Sunday, March 28, 2010

Dems Kick Ass, Take Names: Health Care Reform Act - A Short, Readable Version



Lauren from thinkspin and K. from Citizen K., two fabulous bloggers in their own rights and frequent visitors here at MP, were curious as to whether the new health care reforms in place will keep premiums from rising. And that got me doing my research in earnest again this morning. Purely a serendipitous thing, coming across this abbreviated version from the Senate itself, in a tweet by salleegal. I was extremely grateful to come across her tweet, as I have been looking for a good summary of the changes and timelines for implementation for a week and have not been satisfied enough with any of them to use the content here on the blog. My thanks to all three of you for moving my quest along!

Now I know what you're thinking, that 65 pages of legislation is the last thing you want as weekend reading. Okay, granted, 65 pages is a healthy read, but it's a considerable improvement over the official document, running in the thousands of pages. (And yes, it's a complex topic and it does need all those pages, primarily to keep the insurance companies from wheedling their way around the provisions that will cost them their profits and give Americans reasonable care!) But you and I aren't professional politicians, with aides to read the bill in its entirety, and we have a need for the Reader's Digest version, so to speak.

As I read through the summary of the bill, most of the information regarding the "will health insurance premiums rise?" question is in the first part of the Act, in Title I, Section 2718, the first few pages of the summary. It's an important concern, so it's answered right up front. "Bringing Down The Cost of Health Care Coverage" states that the insurance companies must report yearly how much they spent on patient care, clinical services and all other non-claim costs...in other words, how they spent the money they brought in. That's a good start, right? But the best part of that clause is that 80-85% of money taken in from premiums must be spent on patient care (wait for it...) or must be rebated back to the customer. Yes, that's right! Sounds smart. Sounds fiscally wise. Sounds like we might get some bang for our medical buck. How refreshing is that? And no wonder the insurance companies have been paying through the nose for their "grassroots efforts" to propagandize this Act.

But it gets better: Section 1002 provides funding to states for a health insurance consumer advocate or ombudsman to help you negotiate those payments that insurance tries to pass on to you, or to deal with any limits of care that are placed upon your treatment. Another way to protect against rate hikes.

And in Section 1003, we hit pay dirt. It's entitled, "Ensuring that consumers get value for their dollars,"
and sets up annual review of premium increases. States can now decide who has made "unjust premium increases" and recommend that they are excluded from the exchanges, or pools, of insurers for that state. I thought that I'd previously read that this would go into effect six months down the line, but according to the summary, 1002 and 1003 take effect immediately upon the bill's signing. Now that's a provision that makes sense!

So, to answer your question, Lauren, the states will be watching rate hikes from now on. It's now up to the insurance company to show cause for a rate hike, and unjust premium increases can be rejected by the state. As of now. Right now. Immediately. Now, does it forbid the insurance companies from raising their rates? No. Have many providers rushed ahead to get their increases in before the Act was passed? Oh, yeah. Anthem/Blue Cross up 39-75% for some customers...remember those headlines? But remember, if 80-85% of premiums aren't spent, then they are rebated back to the the enrollees. I am certain that big insurance has their lawyers working around the clock to find loopholes in that one...

So, for now, it appears that companies will have to show just cause for premium increases. And there are all kinds of great provisions in the bill if you give it a read. Just peruse the bold type headers throughout for areas that might affect you, or that you have an interest in exploring. Skip the rest. It won't take long, it's not a horribly challenging read for the most part (it definitely has its "let me re-read that" moments, to be sure), and you'll be surprised by the positive, "people-not-profits"-oriented, "get great, common sense things done for the American people" measures that are put in place in the Health Care Act. It isn't perfect, and it doesn't solve all our competition-type issues, but it's a helluva good first step. It's legislation of which we can be proud. It's reason to be proud of our government again. And between this and the other first-year accomplishments of The President, I think Dems can breathe easy for the midterms..."Hell, no you can't!" may be Boehner's rallying cry, but it's not one that'll win elections. especially once folks start getting their 24 year olds back on their policies and start getting insured again despite their pre-existing conditions. It's really refreshing to see our government do something of, by and for the people again, and that's not just a good feeling, it's a way to win elections, and just plain the right thing to do.

Thanks again to Tweenie for her typing assistance while this momma's back heals - you're a great kid and I am proud you are mine!


So, what do you predict for the months ahead? Will health care reform live up to expectations? Will single-payer make a comeback? Will insurance companies spend billions and find a loophole? I can't wait to hear your reactions to the passage of this historic Act, so comment below at Momma Politico!